From left, Scott and Shields.

Daraine Luton, Sunday Gleaner Reporter

One would think it is elementary for a pathologist to know a fracture. Yet it would seem that Government pathologist, Dr. Ere Sheshiah's supposedly inaccurate finding that Bob Woolmer's hyoid bone had been fractured has caused Jamaica great embarrassment in the investigations of the cricket coach's death.

Dr. Sheshiah based his conclusion that Pakistan coach Bob Woolmer died of "asphyxiation due to manual strangulation" on, among other things, a fractured hyoid bone in the neck of the deceased.

"The right-side tip of the cornua of the hyoid bone is fractured," Dr. Sheshiah wrote in his report. This hyoid bone has turned out to be the bone of contention in the Woolmer debacle.

Three forensic experts - Dr. Michael Pollanen, Dr. Nat Cary and Professor Lorna J. Martin - after viewing digital photographs and X-ray images of the hyoid bone, have concluded that Dr. Sheshiah was dead wrong.

The hyoid bone is located in the neck. It is the only bone in the skeleton not articulated to any other bone. It is supported by the muscles of the neck, and in turn, supports the root of the tongue.

Because of its position, the bone is not usually easily fractured in most situations. In cases of suspicious death, a fractured hyoid is a strong sign of strangulation.

In the January 1996 'PubMed' journal, Dr. Pollanen, noted that the hyoid "is fractured in one third of all homicides by strangulation. On this basis, post-mortem detection of hyoid fracture is relevant to the diagnosis of strangulation." Dr. Pollanen also noted that an unfractured hyoid does not rule out strangulation as a cause of death.

Forensic experts have said that bruises on the neck and blood in the throat are some other physical signs of strangulation.

Photographs of Woolmer's body in the morgue show that there were abrasions on one side of his face. However, medical experts and lay persons alike have argued that this was not enough proof of strangulation, especially because Woolmer's hotel room was otherwise undisturbed. The bruises on his face, they argued, could have been caused by him falling and hitting his head.

In any event, the announcement that Woolmer was murdered would have been delayed if the Jamaica Constabulary Force (JCF) did not have sufficient confidence in Dr. Sheshiah.

Second opinion

On March 21, one day after the post-mortem examination, the police High Command said the opinion of a second pathologist was being sought.

Of course, this pathologist never came; however, Deputy Commis-sioner of Police (DCP) Mark Shields told journalists that the police had consulted with experts and were confident in Dr. Sheshiah's findings that Mr. Woolmer had been murdered.

On March 22, confident that they were dealing with a murder investigation, the police, along with Dr. Sheshiah, went back to Romans Funeral home, where the body was being stored.

Dr. Sheshiah again conducted an examination and at that time, the hyoid bone was removed and the body embalmed. Laterthat day, the police made their grand announcement. "... the matter of Mr. Woolmer's death is now being treated by the Jamaica police as a case of murder," Karl Angel, director of communications at the JCF, read on behalf of commissioner of police, Lucius Thomas.

DCP Shields suggested that because of Woolmer's size, there could have been more than one attacker. He said the police were dealing with a "highly complex murder investigation".

However, now that the police have made a 180-degree turn and have closed the murder investigation, it seems, according to the foreign forensic experts, that Woolmer's attacker could have been his heart.

What exactly happened

Woolmer, according to the autopsy reports, had an enlarged heart. However, there is no clear cause of death and many still buy into the initial notion that Woolmer was murdered and that a big cover-up is taking place.

But what exactly happened in Room 374 at the Jamaica Pegasus, and how far can forensic science help to prove the untimely events that unfolded there on the night of March 17, into the early morning of March 18?

In order to understand the Woolmer debacle, one would have to get a clear understanding as to the background of the case.

Woolmer, a 58-year-old diabetic and coach of the Pakistan cricket team, was found unconscious in his Jamaica Pegasus hotel room at 10:45 a.m., on March 18, after a chambermaid stumbled upon his body.

When Woolmer was found, he was lying on his back in the bathroom. Blood, vomit and faeces were found in the room. Access to the bathroom was made impossible as the massive 250-pounder lay sprawled on the floor with his foot jamming the door.

Woolmer had arrived in Jamaica on March 10, a day before the Cricket World Cup (CWC) opening ceremony in Trelawny, and days after Pakistan and other teams staying in a Trinidad hotel had been forced to evacuate because of a fire scare.

Pakistan, ranked number four in the world and a favourite to win the CWC, lost in the tournament opener to West Indies andthen to Ireland, which meant that they were knocked out at the group stage.

Shortly before his death, Woolmer complained of non-specific symptoms, including headaches and a cough.

On the evening when Ireland knocked Pakistan out, Woolmer, whose contract as coach would have expired this month, said he was going to sleep on his future as coach. He did not wake up, however.

Despite being found at 10:45 a.m., Woolmer's body did not arrive at the nearby University Hospital of the West Indies (UHWI) until just after noon. He was pronounced dead at 12:14 p.m. He was not taken there in an ambulance, according to staff working at the hospital, but rather by a "diplomat van".

Two days after the death, Dr. Sheshiah conducted a post-mortem examination on the body and his initial statement, which came via DCP Shields, was that the cause of death was "inconclusive" and that he needed toxicology and histology results from Woolmer's tissue samples to determine the cause of death.

However, less than six hours later, DCP Shields convened a late- evening press conference in which he announced that enough evidence had surfaced for them to treat the death as "suspicious".

Death by strangulation

Within two days, the police said they had enough evidence to undertake a full-scale murder investigation as Dr. Sheshiah had told them that Woolmer's death was due to "asphyxiation due to manual strangulation".

The JCF then launched a full-scale murder investigation but shelved that mission for good last week based on reviews of Dr. Sheshiah's work, conducted by three foriegn pathologists.

The contrasting views of the experts were made possible due to photographic, x-ray and video evidence of the scene, the post-mortem examination and the hyoid bone, that was removed before Woolmer was cremated.

All three pathologists expressed serious doubt that Woolmer's hyoid bone was broken and all concluded that it was unlikely that he died a violent death brought on by a third party.

Dr. Sheshiah, meanwhile, has said that hestands by his findings but has refused to comment further.

If Woolmer's hyoid was fractured, as claimed by Dr. Sheshiah, then it is a possibility that the Indian-born Englishman who lived in South Africa and coached Pakistan was murdered. But for Dr. Pollanen, there is no dispute. "It is clear from the x-ray that there is no fracture of the hyoid bone. This is a straightforward and non-controversial finding," he said.

"In addition, photographs of the hyoid bone show no evidence of deformity that could be related to fracture," Dr. Pollanen added.

Contributed to his dilemma

Dr. Sheshiah could have made a mistake about a broken hyoid but if he did, he may have contributed to his own dilemma. He wrote that bleeding existed around the region of the hyoid bone, an indication of scarring or fracture. However, Dr. Cary has suggested that even though such bleeding existed, it might have been blood that had drained on to the area and not bleeding caused by trauma.

"Although there appears to be bleeding present adjacent to the hyoid bone, including in the later views taken of the dissected hyoid bone, I am unable to confirm the presence of any hyoid bone fracture," Dr. Cary wrote.

But how could Dr. Sheshiah have got it so wrong when he not only saw bleeding around the hyoid, but also noticed a fracture?

The non-existence of state-of-the-art, first-world forensic equipment has always been a problem in Third-World Jamaica. There are suggestions that if Dr. Sheshiah was indeed wrong in saying the hyoid bone was broken, it may be due to a lack of proper equipment. That however, would be a bit premature as until the Forte Committee investigates and returns a verdict on the way the Woolmer investigations were carried out, the world will not know whether Dr. Sheshiah was really at fault.

Last week, Minister of National Security, Dr. Peter Phillips, mandated former Court of Appeal judge, justice Ian Forte, to review the investigations of the Woolmer case and give a report as to what went wrong.

Gilbert Scott, the permanent secretary in the National Security Ministry, told The Sunday Gleaner last week that he had no idea what technological aid Dr. Sheshiah might have used to determine that Woolmer's hyoid was indeed broken.

Dr. Pollanen's review, if taken as gospel, may contain the answer. He reconstructed the post-mortem with the aid of videographic and digital photographic records and said that the neck had not been not drained by elevating the shoulders to facilitate a forensic neck dissection, and the neck had not been examined using standard forensic dissection procedures. This, Dr. Pollanen said, challenges the validity of Dr. Sheshiah's findings.